Individual
JOHANNA M FORLIVIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
159 BARNEGAT RD, POUGHKEEPSIE, NY 12601
(845) 452-9800
(845) 452-7691
Mailing address
111 CLOCK TOWER CMNS, BREWSTER, NY 10509-4055
(845) 592-4915
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
011693
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02959171
—
NY
Enumeration date
03/08/2007
Last updated
07/24/2018
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